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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 351-356

Adenotonsillectomy in Children With Obstructive Sleep Apnea Syndrome Reduces Health Care Utilization

Ariel Tarasiuk, PhD*,{ddagger}, Tzahit Simon, MA§, Asher Tal, MD{ddagger},|| and Haim Reuveni, MD{ddagger},||,¶

* Sleep-Wake Disorders Unit, Soroka University Medical Center, and Department of Physiology, Beer-Sheva, Israel
{ddagger} Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
§ Department of Economics and Statistics, Clalit Health Care Services, Beer-Sheva, Israel
|| Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Objective. To investigate health care utilization of children with obstructive sleep apnea syndrome (OSAS) 1 year after adenotonsillectomy (T&A).

Methods. A longitudinal, case-controlled, prospective study was conducted at Clalit Health Care Services (CHS), a health maintenance organization in the southern region of Israel. We defined 3 groups of children: 1) children who had OSAS and were treated with T&A (n = 130); 2) children who had OSAS and did not undergo surgery (n = 90); and 3) control subjects who were matched by age, sex, and area of residency (n = 520) and randomly selected from the CHS database. OSAS was verified with polysomnography studies in all patients. Indices of health care utilization were analyzed 1 year before and 1 year after T&A. Medical records in the emergency department and during hospitalization were reviewed for diagnosis before the polysomnography diagnosis.

Results. Mean age of all children with OSAS was 5.6 ± 3.6 years. Total annual health care costs were reduced by one third in children who underwent T&A, whereas there was no change in the control and untreated OSAS groups. T&A was associated with a 60% reduction in the number of new admissions, 39% reduction in emergency department visits, 47% reduction in the number of consultations, and 22% reduction in costs for prescribed drugs. In group 2, the total costs were similar in years 1 and 2.

Conclusions. T&A significantly reduces health care utilization in children with OSAS. Untreated children with moderate and severe OSAS will continue to consume high levels of health care resources. Increased morbidity among children with OSAS is mainly related to upper respiratory tract infections.

Key Words: adenotonsillectomy • children • costs • heath care utilization • OSAS

Abbreviations: OSAS, obstructive sleep apnea syndrome • T&A, adenotonsillectomy • PSG, polysomnographic • CHS, Clalit Health Care Services • HMO, health maintenance organization • RDI, respiratory disturbance index

Received for publication Dec 2, 2002; Accepted Jun 3, 2003.




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